Considering myself a Dr. Doolittle of sorts, always talking to the animals, I reached out to pet a stray cat sitting quietly outside our barn one evening while doing barn chores. This is a grayish fluffy cat I see around the barns every few months or so–he doesn’t put in frequent appearances and reminds me of a kitten we raised on this farm a few years back, though his markings are a bit different, so I know it is not our cat.

We have 6 cats to pet here who claim “us” as their home and family, so there is no lack of fur balls to love. There are probably that many more who hang out, now and then, considering our farm fair game and looking for an occasional free meal. This cat just seemed to need a reassuring pat at that moment or maybe I needed the reassurance. Wrong.

I found myself with a cat attached to my wrist by teeth and claws. It took a bit of an effort to shake him off and he escaped into the night. I then surveyed the damage he inflicted and immediately went to wash my wounds. They were deep punctures near my wrist joint–not good. Lucky for me I was up to date on my tetanus booster.

By the next day the wounds were getting inflamed and quite sore. I know all too well the propensity of cat bites to get badly infected with Pasteurella Multocida, a “bad actor” bacteria that can penetrate deep tissues and bone if not treated with aggressive antibiotics. After getting 6 opinions from my colleagues at clinic, all of whom stood solemnly shaking their heads at my 12 hour delay in getting medical attention, I surrendered and called my doctor’s office. I pleaded for a “no visit” prescription as I was up to my eyeballs in my own patients, and he obliged me. I picked up the antibiotic prescription during a break, sat in the car ready to swallow the first one and then decided to wait a little longer before starting them, knowing they wallop the gut bacteria and cause pretty nasty side effects. I wanted to see if my own immune system might just be sufficient.

So the bacterial infection risk was significant and real but I was prepared to deal with it. For some reason I didn’t really think about the risk of rabies until the middle of the night when all dark and depressing thoughts seem to come real to me.

I don’t know this cat. I doubt he has an owner and it is highly unlikely he is rabies vaccinated. My own cats aren’t rabies vaccinated (and neither am I) though if I was a conscientious owner, they would be. Yes, we have bats in our barns and woods and no, there has not been a rabid bat reported in our area in some time.

But what if this cat were potentially infected with the rabies virus but not yet showing symptoms? Now my mind started to work overtime as any good neurotic will do. Last summer a rabid kitten in North Carolina potentially exposed 10 people when it was passed around a softball tournament, no one aware it was ill until it died and was tested. Lots of people had to have rabies shots as a result.

This cat who had bitten me was long gone–there was no finding him in the vast woods and farmland surrounding us. He couldn’t be kept in observation for 10 days and watched for symptoms, nor could he be sacrificed to examine his neural tissue for signs of the virus.

I called the health department to ask what their recommendation was in a case like this. Do they recommend rabies immune globulin injection which should have been done as soon as possible after the bite? I talked with a nurse who read from a prepared script for neurotic people like me. Feral cats in our area have not been reported to have rabies nor have skunks or raccoons. Only local bats have been reported to have rabies but not recently. This cat would have had to have been bitten by a rabid bat to be rabid. This was considered a “provoked” attack as I had reached out to pet the cat. This was not a cat acting unusually other than having wrapped itself around my arm. No, the Health Dept would not recommend rabies immune globulin in this situation but I was free to contact my own doctor to have it done at my own expense if I wished to have the series of 5 vaccination shots over the next month at a cost of about $3000. Yes, there would be a degree of uncertainty about this and I’d have to live with that uncertainty but she reassured me this was considered a very low risk incident.

I knew this was exactly what I would be told and I would have counseled any patient with the same words. Somehow it is always more personal when the risk of being wrong has such dire consequences. I could see the headlines “Local Doctor Dies From Rabid Cat Bite”.

This is not how I want to be remembered.

Rabies is one of the worst possible ways to die. The cases I’ve read about are among the most frightening I’ve ever seen in the medical literature. Not only is it painful and horrific but it puts family and care providers at risk as well. It also has an unpredictable incubation period of a up to a month or two, even being reported as long as a year after an exposure. What a long time to wait in uncertainty. It also has a prodrome of several days of very nonspecific symptoms of headache, fever and general malaise, like any other viral infection before the encephalitis and other bad stuff hits. I was going to think about it any time I had a little headache or chill. This was assuredly going to be a real test of my dubious ability to stifle my tendency for 4-dimensional worries.

I decided to live with the low risk uncertainty and forego the vaccination series. It was a pragmatic decision based on the odds. My wounds slowly healed without needing antibiotics. For ten days I watched for my attacker cat whenever I went to the barn, but he didn’t put in an appearance. I put out extra food and hoped to lure him in. It would have been just be so nice to see his healthy face and not have to think about this gray cloud hanging over me for the next few months, as I wondered about every stray symptom. No gray kitty to be seen.

Almost a month has gone by now and he finally showed up last night. I could have grabbed him and hugged him but I know better now. No more Dr. Doolittle.

He is perfectly fine and now so am I, cured of a terminal case of worry and hypochondria which is not nearly as deadly as rabies but can be debilitating and life shortening none the less.

From now on, I’ll be contented to just “talk to the animals” like any good Dr. Doolittle. I don’t need to cuddle them.

And so you have a life that you are living only now,
now and now and now,
gone before you can speak of it,
and you must be thankful for living day by day,
moment by moment …
a life in the breath and pulse and living light of the present…~Wendell Berry from Hannah Coulter

~Lustravit lampade terras~
(He has illumined the world with a lamp)
The weather and my mood have little connection.
I have my foggy and my fine days within me;
my prosperity or misfortune has little to do with the matter.
– Blaise Pascal from “Miscellaneous Writings”

photo by Nate Gibson

Is my gloom, after all,Shade of His hand,
outstretched caressingly?~Francis Thompson from “The Hound of Heaven”

My days are filled with anxious and sad patients, one after another after another. They sit at the edge of their seat, struggling to hold back the flood from brimming eyes, fingers gripping the arms of the chair. Each moment, each breath, each heart beat overwhelmed by questions: will there be another breath? must there be another breath? Must life go on like this in fear of what the next moment will bring?

The only thing more frightening than the unknown is the knowledge that the next moment will be just like the last or perhaps worse. There is no recognition of a moment just passed that can never be retrieved and relived. There is only fear of the next and the next so that the now and now and now is lost forever.

Worry and sorrow and angst are contagious as the flu.
I mask up and wash my hands of it throughout the day.
I wish we could be vaccinated to protect us all from these unnamed fears.

I want to say to them and myself:
Stop this moment in time. Stop and stop and stop.
Stop expecting someone or some thing must fix this feeling.
Stop wanting to be numb to all discomfort.
Stop resenting the gift of each breath.
Just stop.
Instead, simply be.

I want to say:
this moment, foggy or fine, is yours alone,
this moment of weeping and sharing
and breath and pulse and light.
Shout for joy in it.
Celebrate it.
Be thankful for tears that can flow over grateful lips
and stop holding them back.

Stop me before I write,
out of my own anxiety,
yet another prescription
you don’t really need.

A wind has blown the rain awayand blown the sky awayand all the leaves away,and the trees stand.I think, I too,have known autumn too long.~e.e. cummings

Be obscure clearly.~E. B. White

As a family doctor in the autumn of a forty year career, I work at clarifying obscurity about the human condition daily, dependent on my patients to communicate the information I need to make a sound diagnosis and treatment recommendation. That is hard work for my patients, especially when they are depressed and anxious on top of whatever they are experiencing physically.

There is still much unknown and difficult to understand about psychology, physiology and anatomy. Then throw in a disease process or two or three to complicate what appears to be “normal”, and further consider the side effects and complications of various treatments — even evidence-based decision making isn’t equipped to reflect perfectly the best and only solution to a problem. Sometimes the solution is very muddy, not pristine and clear.

Let’s face the lack of facts. A physician’s clinical work is obscure even on the best of days when everything goes well. We hope our patients can communicate their concerns as clearly as possible, reflecting accurately what is happening with their health. In a typical clinic day we see things we’ve never seen before, must expect the unexpected, learn things we never thought we’d need to know, attempt to make the better choice between competing treatment alternatives, unlearn things we thought were gospel truth but have just been disproved by the latest double blind controlled study which may later be reversed by a newer study. Our footing is quicksand much of the time even though our patients trust we are giving them rock-solid advice based on a foundation of truth learned over years of education and training. Add in medical decision-making that is driven by cultural, political or financial outcomes rather than what works best for the individual, and our clinical clarity becomes even further obscured.

Forty years of doctoring in the midst of the mystery of medicine: learning, unlearning, listening, discerning, explaining, guessing, hoping, along with a little silent praying — has taught me the humility that any good clinician must have when making decisions with and about patients. What works well for one patient may not be at all appropriate for another despite what the evidence says or what an insurance company or the government is willing to pay for. Each person we work with deserves the clarity of a fresh look and perspective, to be “known” and understood for their unique circumstances rather than treated by cook-book algorithm. The complex reality of health care reform may dictate something quite different.

The future of medicine is dependent on finding clarifying solutions to help unmuddy the health care decisions our patients face. We have entered a time of information technology that is unparalleled in bringing improved communication between clinicians and patients because of more easily shared electronic records. The pitfall of not knowing what work up was previously done can be a thing of the past. The risk and cost of redundant procedures can be avoided. The time has come for the patient to share responsibility for maintenance of their medical records and assist the diagnostic process by providing online symptom and outcomes follow up documentation.

The benefit of this shared record is not that all the muddiness in medicine is eliminated, but that an enhanced transparent partnership between clinician and patient develops, reflecting a relationship able to transcend the unknowns.

Wheels of baled hay bask in October sun:Gold circles strewn across the sloping field,They seem arranged as if each oneHas found its place; together they appealTo some glimpsed order in my mindPreceding my chance pausing here —A randomness that also seems designed.Gold circles strewn across the sloping fieldEvoke a silence deep as my deep fearOf emptiness; I feel the scene requiresA listener who can respond with words, yet whoProlongs the silence that I still desire,Relieved as clacking crows come flashing through,Whose blackness shows chance radiance of fire.Yet stillness in the field remains for everyone:Wheels of baled hay bask in October sun.~Robert Pack “Baled Hay” from Rounding it Out: A Cycle of Sonnetelles (1999).

Each day I am called to see and listen,
to open fully to all that is around me.
From the simple stillness of the fields
surrounding our farm,
to the weeping of those who sit with me
day after day
in their deep fear of emptiness,
their struggle with whether to try to live
or give up and die.

Their deep fear of emptiness renders me silent;
I struggle to respond with words
that might offer up a healing balm
assuring them even in the darkest time
hope lies waiting, wrapped and baled,
radiant as fire,
ready to spill out fragrant,
to bear us silently to a new morning,
to a stillness borne of grace.

Always in the midst of great stress, wading waist-deep in trouble and sorrow, as doctors do, I would glance out a window, open a door, look into a face, and there it would be, unexpected and unmistakable. A moment of peace.

The light spread from the sky to the ship, and the great horizon was no longer a blank threat of emptiness, but the habitation of joy. For a moment, I lived in the center of the sun, warmed and cleansed, and the smell and sight of sickness fell away; the bitterness lifted from my heart.

I never looked for it, gave it no name; yet I knew it always, when the gift of peace came. I stood quite still for the moment that it lasted, thinking it strange and not strange that grace should find me here, too. Then the light shifted slightly and the moment passed, leaving me as it always did, with the lasting echo of its presence. In a reflex of acknowledgment, I crossed myself and went below, my tarnished armor faintly gleaming.~Diana Gabaldon – Claire’s observations from Voyager

I’ve known this moment of peace in the midst of my work; it comes unexpectedly after a day of immersion in troubles and anguish. As I leave the clinic and breathe in a sudden rush of fresh air, and as I drive down our country road as the sun is setting, I remember that for all of us, the sick and the not-yet-sick, there still are moments of grace and beauty.

It isn’t all sad, it isn’t all anxious, it isn’t all anguish. The moment may be brief, it may be elusive.

But it is there. And I seek it out every day.

(written with gratitude to author Diana Gabaldon for her insights into the complex workings of an innovative physician’s mind in her Outlander series of novels, for Caitriona Balfe‘s insightful characterization and understanding of Claire and for Sam Heughan‘s sensitive portrayal of the man who loves her beyond the boundary of time in Starz’ Outlander – if you don’t know these stories yet, you should.)

I felt sadness in that moment because, having been raised in a certain culture, I learned long ago that “sadness” is something that may occur when certain bodily feelings coincide with terrible loss. Using bits and pieces of past experience, such as my knowledge of shootings and my previous sadness about them, my brain rapidly predicted what my body should do to cope with such tragedy. Its predictions caused my thumping heart, my flushed face, and the knots in my stomach. They directed me to cry, an action that would calm my nervous system. And they made the resulting sensations meaningful as an instance of sadness. In this manner, my brain constructed my experience of emotion.

…if you could distinguish finer meanings within “Awesome” (happy, content, thrilled, relaxed, joyful, hopeful, inspired, prideful, adoring, grateful, blissful.. .), and fifty shades of “Crappy” (angry, aggravated, alarmed, spiteful, grumpy, remorseful, gloomy, mortified, uneasy, dread-ridden, resentful, afraid, envious, woeful, melancholy.. .), your brain would have many more options for predicting, categorizing, and perceiving emotion, providing you with the tools for more flexible and functional responses.
~Lisa Feldman Barrett from How Emotions Are Made: The Secret Life of the Brain

Emotions are fleeting. But they are unavoidable and they are the most human of all things. They are not universals; they are arbitrary. But if we feel them deeply and we share them with others, nothing in this life is more real.~Eric Barker on his blog Barking Up the Wrong Tree

If there is anything I’ve come to understand over the decades I’ve been a physician, it is that human beings have emotions that make them uncomfortable and that makes them more difficult to share with others. Sometimes those feelings become so locked up that they leak out of our cells as physical symptoms: headaches, muscle tightness, stomach upset, hypertension. Other times they are so overwhelming we can no longer function in a day to day way – labeled as rage, panic, mood disorder, depression, self-destructive, suicidal.

Somehow we’ve lost the ability to be just sad. Just sad. Sad happens and it happens to us all, some longer than others, some worse than others, some deeper than others. What makes sad more real and more manageable is if we can say it out loud — whatever ‘sad’ means to us on a given day and to describe the feeling in detail can categorize and manage it — and explain it to others who can listen and help.

Strong emotions don’t always need a “fix”, particularly chemical, but that is why I’m usually consulted. Alcohol, marijuana and other drugs tend to be the temporary self-medicated anesthesia that people seek to stop feeling anything at all but it only rages stronger later.

Sometimes an overwhelming feeling just needs an outlet so it no longer is locked up, unspoken and silent, threatening to leak out in ways that tear us up and pull us apart.

Just tell me where you come from, who you are and who you are becoming and then, only then, we might be able to understand why you feel what you do today. Then, armed with that understanding and how you might respond in a different way, tomorrow may well feel a bit better.

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A physician’s chronicle of faith, family and farm life in rural northwest Washington state.

I come from Pacific Northwest farmers going back three generations, the daughter of teachers, married to a son of farmers; we have raised three children who are making a difference in the world as teachers and people of faith.
While keeping my eyes and heart open to the extraordinary things around me, I work as a full time primary care physician in a University setting, as well as a steward of the small farm we call home.
What I can harvest in words or pictures finds its way here.
Contact email: emilypgibson@gmail.com

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Listening to Others…

...whatever is true, whatever is noble, whatever is right, whatever is pure, whatever is lovely, whatever is admirable—if anything is excellent or praiseworthy—think about such things. ... And the God of peace will be with you. Philippians 4: 8 -9

What is my only comfort in life and in death? That I am not my own, but belong—body and soul, in life and in death—to my faithful Savior, Jesus Christ.
~Heidelberg Catechism

Instructions for living a life:
Pay attention.
Be astonished.
Tell about it.
~Mary Oliver

I must consume the abundance of moments now. Days I am overwhelmed, wanting to write the music of my life in a slower tempo … yet this is the glorious dance of now.
So I shall dance in bare feet. For I am on holy ground.
~Ann Voskamp "A Holy Experience"

To do the useful thing, to say the courageous thing, to contemplate the beautiful thing: that is enough for one man's life.
~ T.S. Eliot

A man should hear a little music, read a little poetry, and see a fine picture every day of his life, in order that worldly cares may not obliterate the sense of the beautiful which God has implanted in the human soul.
~Johann Wolfgang von Goethe

To live is so startling, it leaves little room for other occupations.
~Emily Dickinson

I believe in God as I believe that the Sun has risen, not only because I see it, but because by it I see everything else.
~ C. S. Lewis

Remember this. When people choose to withdraw far from a fire, the fire continues to give warmth, but they grow cold. When people choose to withdraw far from light, the light continues to be bright in itself but they are in darkness. This is also the case when people withdraw from God.
~ Augustine

Hello, sun in my face. Hello you who made the morning and spread it over the fields...Watch, now, how I start the day in happiness, in kindness.
~ Mary Oliver

The seed is in the ground. Now may we rest in hope while darkness does its work.
~ Wendell Berry

Nothing will sustain you more potently than the power to recognize in your humdrum routine the true poetry of life.~ Sir William Osler

But the effect of her being on those around her was incalculably diffusive: for the growing good of the world is partly dependent on unhistoric acts, and that things are not so ill with you and me as they might have been, is half owing to the number who lived faithfully a hidden life, and rest in unvisited tombs.
~George Eliot's final sentence in Middlemarch

If the world were merely seductive, that would be easy. If it were merely challenging, that would be no problem. But I arise in the morning torn between a desire to improve the world and a desire to enjoy the world. This makes it hard to plan the day.
~ E.B. White

Geese appear high over us, pass, and the sky closes. Abandon, as in love or sleep, holds them to their way, clear, in the ancient faith: what we need is here. And we pray, not for new earth or heaven, but to be quiet in heart, and in eye clear. What we need is here.~~ "The Wild Geese" Wendell Berry

Let it come, as it will, and don’t be afraid. God does not leave us comfortless, so let evening come.
~ Jane Kenyon from "Let Evening Come"

You can only come to the morning through the shadows.~ J.R.R. Tolkien

If you want to identify me, ask me not where I live, or what I like to eat, or how I comb my hair, but ask me what I am living for, in detail, ask me what I think is keeping me from living fully for the thing I want to live for. ~ Thomas Merton

This life therefore is not righteousness,
but growth in righteousness,
not health but healing,
not being but becoming,
not rest but exercise.
We are not yet
what we shall be,
but we are growing toward it.
The process is not finished
but it is going on.
This is not the end
but it is the road.
~Martin Luther

Ten times a day something happens to me like this - some strengthening throb of amazement - some good sweet empathic ping and swell. This is the first, the wildest and the wisest thing I know: that the soul exists and is built entirely out of attentiveness.
~ Mary Oliver

Love isn’t a function of communication so much as Love is a function of communion.
~ Ann Voskamp

It is not your love that sustains the marriage —
but from now on, the marriage that sustains your love.
~ Dietrich Bonhoeffer

She has done what she could...
~Mark 14:8

What do you mean? Do you wish me a good morning, or mean that it is a good morning whether I want it or not; or that you feel good on this morning; or that it is a morning to be good on?~ J. R. R. Tolkien from The Hobbit